Central Sleep Apnea – Diagnosis and Treatment
Diagnosis
To find out if someone has central sleep apnea (CSA), a healthcare provider first looks at the person’s symptoms and medical history. If needed, the patient visits a sleep specialist for more in-depth tests.
The main test is polysomnography, sometimes called a sleep test. This overnight exam at a sleep center tracks:
- Brain and heart activity
- Lung function
- Breathing patterns
- Movements of arms and legs
- Blood oxygen levels
There are two types of sleep studies:
- Full-Night Study: The team measures everything throughout the entire night.
- Split-Night Study: The staff monitors during the first part, and if central sleep apnea is found, they may start treatment during the second half.
A sleep study helps specialists spot different types of sleep apnea and other sleep problems, like repetitive limb movements or narcolepsy.
If they detect central sleep apnea, they use the apnea-hypopnea index (AHI) to measure how often breathing issues happen per hour of sleep and decide how severe the condition is.
Specialists such as neurologists or cardiologists may join the care team. If they suspect other health issues, they may order brain or heart scans. This thorough approach ensures the team makes the right diagnosis and treatment plan.
Key Diagnostic Tools
| Tool | What It Checks | Why It’s Important |
|---|---|---|
| Polysomnography | Breathing, heart, brain, oxygen | Finds CSA and OSA |
| Apnea-Hypopnea Index (AHI) | Number of events/hour | Shows severity |
| Medical Imaging | Head or heart structure | Detects other causes |
Treatment
Doctors can manage central sleep apnea with a combination of therapies, devices, and medications, depending on the underlying cause and the severity of symptoms.
They tailor the treatment plan to each individual’s needs. The chosen approach may involve more than one type of therapy.
Key treatments include:
- Positive airway pressure devices
- Reducing or adjusting opioid medications
- Using certain medicines
- Supplying extra oxygen during sleep
- Addressing related health problems
- Surgical or device-based procedures
The following table shows some treatments and considerations:
| Treatment | Purpose | Notes |
|---|---|---|
| CPAP (Continuous Positive Airway Pressure) | Keep airway open | First-line treatment, uses a mask and device |
| BPAP (Bilevel Positive Airway Pressure) | Adjust pressure for breaths | Different pressure when inhaling/exhaling |
| ASV (Adaptive Servo-Ventilation) | Stabilize breathing pattern | Not for those with certain heart conditions |
| Supplemental Oxygen | Increase oxygen levels | Can help during sleep |
| Acetazolamide and others | Stimulate breathing | Used if airway pressure devices are not tolerated |
| Phrenic nerve stimulation | Trigger breathing with a device | Implanted system, suitable for some severe cases |
| Reducing Opioid Medicines | Lower risk if opioids are the cause | Adjusts medications as supervised by doctor |
| Weight loss and treating chronic diseases | Reduce contributing factors | Addresses root causes where possible |
Surgeries or Device-Assisted Interventions
In some cases, the care team may recommend surgery or special devices. One option is an implantable system that helps the body regulate breathing during sleep.
Phrenic Nerve Stimulation
- A specialist places a device under the skin in the chest, which sends small electrical pulses to the nerve controlling the diaphragm.
- This device helps prompt regular breaths, especially in people with moderate to severe central sleep apnea.
- The phrenic nerve stimulator uses a battery-powered generator to send gentle rhythmical signals while sleeping.
- This method can support a more natural breathing pattern and reduce interruptions during the night.
- A specialist performs the procedure to insert the device, mainly when other treatments such as CPAP or medications are not effective or cannot be used.
- Researchers continue to study how helpful and safe this approach is in the long term.
Other Procedures
- Surgeons rarely perform airway surgeries for central sleep apnea, as the problem usually starts from the brain or nervous system, not a physical blockage.
- Providers mainly consider these device-based treatments when standard therapies like positive airway pressure or supplemental oxygen do not lead to enough improvement.
Healthcare providers can help design a suitable therapy plan, review device options, and answer questions about available procedures.
Getting Ready for Your Visit
Steps to Take Before Your Appointment
1. Organize Your Medical Records
Bring copies of any past sleep studies or relevant test results, or ask to have them sent directly to the clinic. This helps the sleep specialist understand past findings and see any changes over time.
2. Involve Someone Who Observes Your Sleep
Bring a partner, close friend, or family member who has noticed your sleep patterns, snoring, or pauses in breathing. They can describe what happens while you sleep.
3. Make a List of Symptoms and Concerns
Write down any symptoms you have noticed. This might include loud snoring, gasping for air during sleep, waking up with a dry mouth or sore throat, morning headaches, or feeling very tired during the day.
Also include when these symptoms started and how often they occur.
4. Track Changes in Your Life and Health
Note any big changes such as new stress, recent illnesses, or adjustments in your daily routine. Include health conditions you already have, such as heart disease or stroke.
5. List Medications and Supplements
Make a table or list of all medications, vitamins, and supplements you take, with the amount and how often you take them.
| Name of Medication/Supplement | Dose | How Often |
|---|---|---|
| Example: Lisinopril | 10mg | Once daily |
6. Write Down Questions
Prepare questions for the doctor. Some examples include:
- What might be causing my symptoms?
- Which tests should I have?
- Are there options for treatment?
- Will sleep apnea affect my other medical problems?
Tip: There are no silly questions. Ask your healthcare team about anything you do not understand.
What Your Health Care Provider Might Ask
During the appointment, your provider might ask questions such as:
- How long have your symptoms lasted? Are they steady or do they come and go?
- What is your normal sleep pattern? How much sleep do you get, and is it often disturbed?
- Do you snore, or has someone told you that you stop breathing while asleep?
- Do you wake up feeling refreshed or still very tired? Have you noticed symptoms like dry mouth, sore throat, or headaches in the morning?
- Do you ever wake up short of breath or find it hard to breathe at night?
- Do you have trouble staying awake during the day?
- Do you have any other medical conditions, such as heart problems or a history of stroke?
